Is timing everything? The influence of gestational age, birth weight, route, and intent of delivery on outcome in gastroschisis.

摘要

BACKGROUND/PURPOSE: Optimal perinatal treatment in gastroschisis remains uncertain. We sought to determine the effect of gestational age (GA), birth weight (BW), and intended and actual route of delivery on outcomes in gastroschisis. METHODS: Cases were abstracted from a national gastroschisis database. Outcomes analyzed by route of delivery, delivery plan conformity, BW, and GA included survival, closure success, ventilation days, total parenteral nutrition days, and length of hospital stay. Logistic regression for continuous and categorical variables was performed. RESULTS: One hundred ninety-two babies (56% male) born at mean GA of 36.1 +/- 2.1 weeks, with mean BW of 2536 +/- 557 g, were included. One hundred eighty-three (95%) survived. Of 145 pregnancies with an antenatal delivery plan, vaginal delivery was intended in 77% and actually occurred in 119 pregnancies, with the remainder being planned (33; 17%) or emergency (40; 21%) cesarean deliveries. A delivery conforming to the antenatal plan occurred in 74 (51%). Birth weight and GA were significant inverse predictors of ventilator and total parenteral nutrition days and length of hospital stay, but not survival. Delivery route did not predict any outcome; however, "nonconformers" were born at lower BW and GA than "conformers," and they showed trends toward poorer nonmortality outcomes. CONCLUSIONS: Gestational age, BW, and conformity to an antenatal birth plan are predictors of outcome in gastroschisis, whereas actual route of delivery is not.